Without resolution, rancor between opponents and supporters to the practice would continue to divide the profession. The selected literature would give valuable insights on the current situation of evidence based nursing practice. Moreover, both sides of the opposing groups would be given due consideration to give the reader a balanced view on the issues.
Simpson (2004) traced the origins of evidence based nursing practice (EBN). It began in the 1970's when the clamor for better health care delivery required research to be part of professional development (p.10). The University of Minnesota defined evidence based nursing as "the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise, and patient preferences." (p.10) The University also proposed three areas of research competence that should be developed. They include: "interpreting and using research, evaluating practice, and conducting research." (p.10) Simpson (2004) also included the steps required to gain competence. First, issue identification is an important aspect of problem definition. Second, nurses must be able to conduct research on related literature to support or augment their current knowledge. Third, nurses should be able to formulate criteria used to evaluate evidence. Finally, actions and decision should be validated against existing evidence to ensure that the delivery of service is optimum (p.10).
Rycroft-Malone et al (2003) identified what constituted as evidence in the EBN. Knowledge from "research, clinical experience, patients, clients and carers, and local context and environment" all comprised the knowledge base (p.83). In the order of priority, research came first. Evidences coming from research were fully supported and could validate information gathered (p.83). Next came clinical experience where accumulated knowledge through practice could be drawn when necessary. In this aspect, health care professionals were valued and they do derive their care delivery options through previous experiences (p.84). Third, the personal knowledge, experiences and preferences of the patients, their kin or caregiver should be considered (p.85). Finally, evidences from local context could be drawn from "audit and performance data; patient stories and narratives; knowledge about the culture of the organization and individuals within it; social and professional networks; information from 360 degree feedback; and local and national policy." (p.86)
As an emerging practice paradigm, Wallace, Shorten and Russell (1997) cautioned that adopting evidence based nursing should be a contemplated decision because aside from professional responsibilities, evidence based nursing has economic, ethical and moral implications that could be drivers of future developments in nursing practice (p.149). French (1999) enumerated the critical features of evidence based practice. Essentially, it is problem based that could consolidate pertinent research information to implement a better delivery of health care services. The incorporation of first and second hand information to strengthen decision-making is also a feature of evidence based practice. Finally, like any professional development agenda, it aims to improve the quality of service (p.76).
Issues and Challenges
Closs and Cheater (1999) cited the presence of touchy issues that fueled the debate between